Is IM more limiting than FM if you are not looking to subspecialize?

[PotGoblinsales10]

Lets say you want to be a generalist.

As an IM you can do adult primary care or adult hospitalist

As FM: you can do adult and pediatric primary care, adult and pediatric hospitalist, urgent care, some ER.

I do think I am oversimplifying things, but let me know the best path for someone who is a generalist.

Also, as a hospitalist: does FM know the amount and extent of medicine IM knows? As an example: Emergency Medicine wouldnt go into the details of IM.

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[HoldTheCoffee]

I think it really depends on how you envision your career. In general, I don't think it's possible for someone to complete family medicine training and have as much depth of knowledge as someone who did a full pediatric, IM, or EM residency. Where I trained, FM had their own inpatient service and basically never crossed wires with the IM services (not sure how it worked on the peds side but it's probably the same). I also never saw a FM-trained attending running the show in the ED. In that vein, I'm not sure how easy it would be to become a pediatric hospitalist coming out of FM training if other people applying for the job did full peds training

 

[IMreshopeful]

Lets say you want to be a generalist.

As an IM you can do adult primary care or adult hospitalist

As FM: you can do adult and pediatric primary care, adult and pediatric hospitalist, urgent care, some ER.

I do think I am oversimplifying things, but let me know the best path for someone who is a generalist.

Also, as a hospitalist: does FM know the amount and extent of medicine IM knows? As an example: Emergency Medicine wouldnt go into the details of IM.

No, FM training is definitely not as comprehensive for inpatient training as a hospitalist as IM residency. The majority of their time is outpatient and that is where their strength lies. I went to residency at an institution where we had an inpatient FM service - their management of some inpatient issues, particularly the critically ill, was often questionable. For example, transfusing a cirrhotic platelets for GIB when Plt count 80, not giving ASA to patient with NSTEMI but starting heparin gtt on a patient without any chest pain or trop leak etc. I’m sure there are good inpatient FM docs around but I don’t think the residency typically gives you as strong a foundation for inpatient medicine. You also don’t rotate on subspecialty services, so there’s no exposure to the actual rounds and decision making done by some of the sub specialists consulting on your patients.

So if you want to do inpatient I would consider IM or med peds

 

[mszzeta]

Lets say you want to be a generalist.

As an IM you can do adult primary care or adult hospitalist

As FM: you can do adult and pediatric primary care, adult and pediatric hospitalist, urgent care, some ER.

I do think I am oversimplifying things, but let me know the best path for someone who is a generalist.

Also, as a hospitalist: does FM know the amount and extent of medicine IM knows? As an example: Emergency Medicine wouldnt go into the details of IM.

It depends what you want to do and the specific programs (all FM programs are primary care heavy, but lots of IM programs are either hospitalist heavy or subspeciality heavy)

If you want to become a primary care physician, I do believe FM beats most IM programs. In most IM program the primary care training is very limited and most residents have limited exposure to outpatient procedures (joint tap, I&D, skin biopsy, some FM program even do sigmoidoscopy), women health and gyn procedures, derm, psych meds, etc. And FM is most suitable for practicing in remote area with specialist shortage (I have even seen FM physician running ED and ICU in remote areas)

Otherwise, IM has more advantage in hospital medicine and subspeciality.

It should be noted that for those who are foreigners and needs visa, it is extremely difficult to match into a FM program

 

[rokshana]

It should be noted that for those who are foreigners and needs visa, it is extremely difficult to match into a FM program

huh? that is the easiest specialty for F/IMGs to match.

 

[mszzeta]

huh? that is the easiest specialty for F/IMGs to match.

It matters little where you graduated from your medical school, but matters very much on your cultural background. Only FM would rather consider someone who is not the smartest but US born and know US culture best than a foreigner who is smart enough to have the potential to win Noble prize

 

[anonperson]

It matters little where you graduated from your medical school, but matters very much on your cultural background. Only FM would rather consider someone who is not the smartest but US born and know US culture best than a foreigner who is smart enough to have the potential to win Noble prize

The hell are you talking about?

Who's this foreigner who couldn't match into FM but could have won the Nobel prize?

I hope you aren't talking about yourself...

 

[Mad Jack]

Being FM is more limiting geographically if you want to do hospitalist work, as many more competitive markets only take IM or peds trained hospitalists. ER work is also rare in desirable areas. The only real edge FM has in competitive markets is urgent care positions, which heavily favor FM and EM training. In the sticks, anything goes though

 

[IMreshopeful]

It matters little where you graduated from your medical school, but matters very much on your cultural background. Only FM would rather consider someone who is not the smartest but US born and know US culture best than a foreigner who is smart enough to have the potential to win Noble prize

Wtf is this saying

 

[VA Hopeful Dr]

Wtf is this saying

Apparently us family doctors are racist?

 

[rokshana]

It matters little where you graduated from your medical school, but matters very much on your cultural background. Only FM would rather consider someone who is not the smartest but US born and know US culture best than a foreigner who is smart enough to have the potential to win Noble prize

You must be projecting your experience but FM is probably the most I/FMG friendly of specialties...EVERY specialty wants someone that is knowledgeable of the US healthcare system and of American culture...you are, after all, taking care of people living in the US...competitive specialties have the luxury of being able to have enough US seniors to pick from that they don’t need to have to take foreign students so the FMGs they take are the Uber competitive students.
Until the last few years FM, peds, and even IM had lots of unfilled spots and needed I/FMGs to fill those spots so students with lower step scores, multiple attempts, visa requirements were considered.
Now it’s getting harder for I/FMGs because there are more US seniors and even they are going unmatched...red flags are less tolerated because the programs have plenty of applicants that don’t have them.

 

[mszzeta]

You must be projecting your experience but FM is probably the most I/FMG friendly of specialties...EVERY specialty wants someone that is knowledgeable of the US healthcare system and of American culture...you are, after all, taking care of people living in the US...competitive specialties have the luxury of being able to have enough US seniors to pick from that they don’t need to have to take foreign students so the FMGs they take are the Uber competitive students.
Until the last few years FM, peds, and even IM had lots of unfilled spots and needed I/FMGs to fill those spots so students with lower step scores, multiple attempts, visa requirements were considered.
Now it’s getting harder for I/FMGs because there are more US seniors and even they are going unmatched...red flags are less tolerated because the programs have plenty of applicants that don’t have them.

I am talking about US born IMG vs non-US born IMG, not even a touch on AMG who obviously has much more advantage on matching any specialty. And this is because cultural connection is very crucial and sensitive in FM practice

 

[rokshana]

I am talking about US born IMG vs non-US born IMG, not even a touch on AMG who obviously has much more advantage on matching any specialty. And this is because cultural connection is very crucial and sensitive in FM practice

you are still wrong...of all the specialties, FM is the most attainable of specialities for I/FMGs, visa requiring or not.

 

[mszzeta]

you are still wrong...of all the specialties, FM is the most attainable of specialities for I/FMGs, visa requiring or not.

It is definitely easy compared to most specialties like surgical specialty, derm, rad onc etc. But different to IM, ped, psych, path regarding to recruitment style/preference

 

[rokshana]

It is definitely easy compared to most specialties like surgical specialty, derm, rad onc etc. But different to IM, ped, psych, path regarding to recruitment style/preference

sigh

 

[Vandalia]

I am talking about US born IMG vs non-US born IMG, not even a touch on AMG who obviously has much more advantage on matching any specialty. And this is because cultural connection is very crucial and sensitive in FM practice

I have been doing this almost certainly since before you were born, and I will give you an unpalatable truth: rarely, if ever, is the smartest person the best physician. I have known many truly brilliant physicians who could not hold down a job and had dozens of malpractice suits; likely in the same county there was a physician who had the ability of an MS-III but was beloved and never saw the inside of the courthouse.

Medicine is far more of an art than a science. That is why those residency programs don't care about the Nobel Prize... that is for those who spend their days with test-tubes and rats..

 

[GastriqueGraffin]

I have been doing this almost certainly since before you were born, and I will give you an unpalatable truth: rarely, if ever, is the smartest person the best physician. I have known many truly brilliant physicians who could not hold down a job and had dozens of malpractice suits; likely in the same county there was a physician who had the ability of an MS-III but was beloved and never saw the inside of the courthouse.

Medicine is far more of an art than a science. That is why those residency programs don't care about the Nobel Prize... that is for those who spend their days with test-tubes and rats..

This is so true. When people say “I love my doctor” this has very little to do with clinical skill and knowledge and almost everything to do with personality and showing that you care (being easy to reach and schedule with, remembering personal facts about patients, sounding empathetic, etc). Basically Patch Adams will never be sued and will have great reviews while Dr House will be the opposite.

 

[doctorbeastmode]

Back to the OPs original question - you really need to decide now if you want to be good at one thing or decent at a couple. FM don’t get the same training as IM, PEDS, ER, or OB. Because they split time so much, this isn’t really something you can argue - more just a fact of life.

The upshot is that is that your scope within each of those fields will be limited. You won’t be as desirable at top jobs in good cities as if you had focused on one area. Especially if you think there’s any chance you want to specialize or live in NYC, SF, Chicago, etc. then FM may be surprisingly limiting for you.

If you want to do rural medicine and do a little of everything and mostly be outpatient, FM is a decent option. Outside of that, the trend of medicine is definitively moving away from the jack of all trades / master of none model. OB practices want OB, hospitals want hospitalists and specialists, etc. That’s especially true in OB - given the malpractice environment, very few FM outside of rural areas do OB anymore.

 

[GastriqueGraffin]

If you are interested in inpatient and outpatient, adults and peds, then do Med/Peds combined residency. That extra year will open many more doors. Otherwise just decide inpatient vs outpatient, adult vs peds.

 

[doctorbeastmode]

Strongly recommend just deciding adult vs peds unless you’re truly torn or have some niche like congenital heart disease and you want to run a transitions clinic. Again, meds peds is NOT better that pure medicine (if you want to do adult) or pure peds (if you want to do peds). Like I said before - it’s just math.

 

[VA Hopeful Dr]

Outside of that, the trend of medicine is definitively moving away from the jack of all trades / master of none model. OB practices want OB, hospitals want hospitalists and specialists, etc. That’s especially true in OB - given the malpractice environment, very few FM outside of rural areas do OB anymore.

The family medicine job market begs to differ

 

[Vandalia]

The family medicine job market begs to differ

I would agree. It is more accurate to say the market is bifurcating. On the one hand there is demand for the true primary care physician who can handle everything the family throws at him; or more specifically can like a mailman sort it out to the correct specialist and then interpret and integrate the results. At the other extreme, the hyper-specialist like the GI with advanced endoscopy training, or the cardiologist with additional fellowship training. If there is a weakness in the market, it would be in the middle for the "generalist" cardiologist, (or orthopedic surgeon, or radiologist.)

However, keep in mind that the practice of medicine is always local; the trends where I am may not be the same where you practice (or intend to practice.)

 

[doctorbeastmode]

I would agree. It is more accurate to say the market is bifurcating. On the one hand there is demand for the true primary care physician who can handle everything the family throws at him; or more specifically can like a mailman sort it out to the correct specialist and then interpret and integrate the results. At the other extreme, the hyper-specialist like the GI with advanced endoscopy training, or the cardiologist with additional fellowship training. If there is a weakness in the market, it would be in the middle for the "generalist" cardiologist, (or orthopedic surgeon, or radiologist.)

However, keep in mind that the practice of medicine is always local; the trends where I am may not be the same where you practice (or intend to practice.)[/QUOT

I would agree. It is more accurate to say the market is bifurcating. On the one hand there is demand for the true primary care physician who can handle everything the family throws at him; or more specifically can like a mailman sort it out to the correct specialist and then interpret and integrate the results. At the other extreme, the hyper-specialist like the GI with advanced endoscopy training, or the cardiologist with additional fellowship training. If there is a weakness in the market, it would be in the middle for the "generalist" cardiologist, (or orthopedic surgeon, or radiologist.)

However, keep in mind that the practice of medicine is always local; the trends where I am may not be the same where you practice (or intend to practice.)

All fair points - I think there are plenty of great jobs for FM docs and should continue to be.

That being said, I think the market for it in large centers is drying up and EMR / ACA issues are making it harder to be a solo guy who opens your own practice. My comments were directed specifically toward large cities.

 

[doctorbeastmode]

Researchers Explore Diminishing Scope of FP Practice

 

[IMreshopeful]

The family medicine job market begs to differ

Might be a regional thing - on the coasts my experience has been (aside from super rural places like Appalachia) most FM docs do vast majority outpatient adult with smattering of peds and little to no OB. May be different in Midwest. In big cities, very tough for FM to do much beyond outpatient adult medicine.

I think there’s a role for it, but I do think that by and large the more specialized we get as a society wrt medicine the less the role of the generalist is. Which is a shame - I know old school PCPs who used to do EGD and flex sigs, exercise treadmill testing, whole gamut of derm and MSK procedures. Nowadays seems like it’s mostly primary care with occasional cosmetic stuff (varicose veins etc)

 

[VA Hopeful Dr]

Might be a regional thing - on the coasts my experience has been (aside from super rural places like Appalachia) most FM docs do vast majority outpatient adult with smattering of peds and little to no OB. May be different in Midwest. In big cities, very tough for FM to do much beyond outpatient adult medicine.

I think there’s a role for it, but I do think that by and large the more specialized we get as a society wrt medicine the less the role of the generalist is. Which is a shame - I know old school PCPs who used to do EGD and flex sigs, exercise treadmill testing, whole gamut of derm and MSK procedures. Nowadays seems like it’s mostly primary care with occasional cosmetic stuff (varicose veins etc)

Yep, completely agree with all of that. Outside rural, very few full scope jobs these days. But the job market for outpatient PCP jobs is insane - even on the coasts and in large cities. I live in SC and there are currently 37 jobs listed for the state. That's just from the AAFP website. Go to Practice Link and they have 70. Using those sites, I found roughly a dozen jobs in SF.

I have a family member who has been a family doctor since the late 70s. He doesn't miss the full scope days, and from remembering how much he worked back then I can see why.

 

[sunshinefl]

Researchers Explore Diminishing Scope of FP Practice

most FM docs do vast majority outpatient adult with smattering of peds and little to no OB.

This is actually good for someone like me who is mostly interested in adult outpatient medicine. I’m going in to second year, so there is still time, but I have been consistent with my interests in, as I call it, “awake adult medicine.” Within that I have interests in internal medicine, IM to ID, IM to allergy+immunology, neurology, and psychiatry. I have consistently seen people say that if you want to do outpatient PCP, Family Medicine is better. And conversely that if you want to do hospitalist (or go on to an IM subspecialty obviously), IM is better. But I never wanted to do OB or Peds. There’s the catch. If you want to just act as an adult PCP, is FM or IM better? Well, according to these posts FM (non-rural) scope is moving in a direction that I would like.

 

[VA Hopeful Dr]

This is actually good for someone like me who is mostly interested in adult outpatient medicine. I’m going in to second year, so there is still time, but I have been consistent with my interests in, as I call it, “awake adult medicine.” Within that I have interests in internal medicine, IM to ID, IM to allergy+immunology, neurology, and psychiatry. I have consistently seen people say that if you want to do outpatient PCP, Family Medicine is better. And conversely that if you want to do hospitalist (or go on to an IM subspecialty obviously), IM is better. But I never wanted to do OB or Peds. There’s the catch. If you want to just act as an adult PCP, is FM or IM better? Well, according to these posts FM (non-rural) scope is moving in a direction that I would like.

If you know 100% that you do not want to see any children, I would go with IM. FM residency has a pretty good chunk of time doing OB and peds, and if you have no interest in either of those populations then not only will you hate that part of residency but its essentially worthless time for you.

 

[doctorbeastmode]

Strong second. If you want to do purely adult outpatient general medicine, you will be MUCH better served by going to a top both IM program and doing a primary care track. Lots of great IM places have them from the west coast (UCSF) to Midwest (UW Madison) to east coast (Columbia).

Again, it’s just a matter of time. If you go to a top notch IM program with a focus on primary care, you can just spend three years becoming awesome at that. If you go to a FM program, you’re going to waste 30%-50% of your training learning how to treat RSV and wathing someone else do c-sections.

I love FM but if you want to do adult outpatient you should do an IM residency with a primary care track.

 

[doctorbeastmode]

Also, in your post you said you may have an interest in ID or allergy/immuno. There’s no pathway to those specialties out of FM, so you should definitely do IM. Not only will you have comparable or better training (provided you avoid research heavy centers that don’t emphasize primary care, looking at you WashU), but also you’ll have the option of specializing. News flash: tons of people who think they want to do primary care wind up doing an outpatient IM specialty bc they like the content, lifestyle, or salary those offer.

Based on what you said, IM is the right choice. Obviously that’s not true for everyone, but based on what you said it is.

 

[IMreshopeful]

This is actually good for someone like me who is mostly interested in adult outpatient medicine. I’m going in to second year, so there is still time, but I have been consistent with my interests in, as I call it, “awake adult medicine.” Within that I have interests in internal medicine, IM to ID, IM to allergy+immunology, neurology, and psychiatry. I have consistently seen people say that if you want to do outpatient PCP, Family Medicine is better. And conversely that if you want to do hospitalist (or go on to an IM subspecialty obviously), IM is better. But I never wanted to do OB or Peds. There’s the catch. If you want to just act as an adult PCP, is FM or IM better? Well, according to these posts FM (non-rural) scope is moving in a direction that I would like.

I echo what others say - if your goal is to do outpatient medicine and have the opportunity to do outpatient heavy subspecialty then do not do FM. Definitely do IM. The training is better and the fellowship opportunities are there. You cannot pursue those fellowships from FM.

For perspective pretty much any medical subspecialty can be made primarily outpatient with the exception of critical care. There’s plenty of cardiology jobs which are primarily outpatient with a smattering of echo, nucs, etc and no inpatient time - the trade off being that the reimbursement usually is lower. So if your love is truly outpatient you can make anything work.

 

[sunshinefl]

I echo what others say - if your goal is to do outpatient medicine and have the opportunity to do outpatient heavy subspecialty then do not do FM. Definitely do IM. The training is better and the fellowship opportunities are there. You cannot pursue those fellowships from FM.

For perspective pretty much any medical subspecialty can be made primarily outpatient with the exception of critical care. There’s plenty of cardiology jobs which are primarily outpatient with a smattering of echo, nucs, etc and no inpatient time - the trade off being that the reimbursement usually is lower. So if your love is truly outpatient you can make anything work.

Thanks everyone for the input! Just to be clear I would decide between those specialties I listed eventually. I know that you can’t go FM to ID or allergy+immunology. My interests in IM for residency would be for adult PCP -or- ID -or- A+I. I wouldn’t apply and go into residency without knowing what the end goal was (Although there is the possibility of flexibility therein). I do still have interest in psych and neuro as well. Those are my 5 current interests. I will see how everything goes over 2nd and 3rd year.

At my school we are paired with a community PCP preceptor for all of first year in a glorified shadowing role so far anyway (done, did with internal medicine), and then a different PCP preceptor for all of second year. Our school allows us to request a focus within the practice, if available, and I requested an HIV-focused preceptor (one of the options given). So hopefully I get that slot for 2nd year.

 

[E'02]

As an internist who has worked outpatient clinics alongside FP physicians in a community that's considered rural, my FP colleagues are top-notch, moreover, hands down they all had great training and experience doing procedures. Other than blood draws, ABGs and central lines we had no other residency training essential for primary care such as I+D, suturing, wound care, etc. So for primary care I often wonder if the FP route would have been better...

 

[gutonc]

As an internist who has worked outpatient clinics alongside FP physicians in a community that's considered rural, my FP colleagues are top-notch, moreover, hands down they all had great training and experience doing procedures. Other than blood draws, ABGs and central lines we had no other residency training essential for primary care such as I+D, suturing, wound care, etc. So for primary care I often wonder if the FP route would have been better...

The thing is...all that stuff is available for you in an IM residency...you just need to seek it out in some, more than others. And that might mean doing a few clinic rotations with the FM clinic (or gunning for procedures on the UC side of the ED in your ER rotation) unless your program has attendings who do this stuff on the reg. It's not hard to do this stuff and you can easily learn it...you just might need to go out of your way a little to learn it.

 

[IMreshopeful]

As an internist who has worked outpatient clinics alongside FP physicians in a community that's considered rural, my FP colleagues are top-notch, moreover, hands down they all had great training and experience doing procedures. Other than blood draws, ABGs and central lines we had no other residency training essential for primary care such as I+D, suturing, wound care, etc. So for primary care I often wonder if the FP route would have been better...

I&D, suturing, etc are pretty easy skills to learn anywhere for the kind of stuff you’ll see in a clinic. I don’t think doing an IM residency is limiting.

 

[VA Hopeful Dr]

The thing is...all that stuff is available for you in an IM residency...you just need to seek it out in some, more than others. And that might mean doing a few clinic rotations with the FM clinic (or gunning for procedures on the UC side of the ED in your ER rotation) unless your program has attendings who do this stuff on the reg. It's not hard to do this stuff and you can easily learn it...you just might need to go out of your way a little to learn it.

Agreed. I would say if we averaged out every FM program and compared to every IM program, us FM folks probably get more experience doing outpatient procedures. Obviously on an individual level this will vary by program, but it does mean if you go IM you might have to make an effort to get those procedures down.

That being said, most outpatient procedures are really easy to learn. My wife is an internist who never injected anything outside of a knee in residency (and that exactly once). So one afternoon I came out, proctored her on a carpal tunnel injection, and she's probably done a half dozen since then with no problems. Heck, I've done things since getting out that I didn't do in residency. A good procedure book and a willing patient can do wonders.

 

[E'02]

The thing is...all that stuff is available for you in an IM residency...you just need to seek it out in some, more than others. And that might mean doing a few clinic rotations with the FM clinic (or gunning for procedures on the UC side of the ED in your ER rotation) unless your program has attendings who do this stuff on the reg. It's not hard to do this stuff and you can easily learn it...you just might need to go out of your way a little to learn it.

Agree

 

[LeroyJenkinsMD]

FM resident here. I will graduate with more inpatient than clinic encounters. Multiple months in the ICU, etc. plenty of elective time for sub specialty training. I am signing to be a hospitalist in a major city and will do DPC when I am out of debt and burned out. FM hospitalists are 100% supported by the society of hospital medicine and the FM will not be pushed out when HM becomes a sub specialty of IM/FM similar to geriatrics sleep etc

 

[CCM-MD]

Hospitals in my area don't hire FM trained as hospitalists.

 

[LeroyJenkinsMD]

Hospitals in my area don't hire FM trained as hospitalists.

There is absolutely institutional bias, politics, etc. I have seen jobs in surburban areas hiring only FM hospitalists as well although this is admittedly less common. FM training is good for rounding on uncomplicated kids, newborn nursery, circumcisions, pregnant women with simple medical complaints, as well as bread and butter adult medicine—CHF, pneumonia, cellulitis, alcohol withdrawal, DKA, and consult specialties when needed as well.

 

[VA Hopeful Dr]

Hospitals in my area don't hire FM trained as hospitalists.

In 3 of the 4 major cities in my state, FM isn't being hired for hospitalists as well.

 

[VA Hopeful Dr]

There is absolutely institutional bias, politics, etc. I have seen jobs in surburban areas hiring only FM hospitalists as well although this is admittedly less common. FM training is good for rounding on uncomplicated kids, newborn nursery, circumcisions, pregnant women with simple medical complaints, as well as bread and butter adult medicine—CHF, pneumonia, cellulitis, alcohol withdrawal, DKA, and consult specialties when needed as well.

Dude, this is a physician forum. They know what FM is.

 

[IMreshopeful]

There is absolutely institutional bias, politics, etc. I have seen jobs in surburban areas hiring only FM hospitalists as well although this is admittedly less common. FM training is good for rounding on uncomplicated kids, newborn nursery, circumcisions, pregnant women with simple medical complaints, as well as bread and butter adult medicine—CHF, pneumonia, cellulitis, alcohol withdrawal, DKA, and consult specialties when needed as well.

It’s highly dependent on where you train. I get the sense that if you’re at a place where IM is strong then your training inpatient may suffer. The FM inpatient team at my hospital (which has a strong IM residency) is absolutely atrocious. I’ve gotten so many horrible consults from them (didn’t look at telemetry, didn’t read the chart, mischaracterized disease, didn’t know how to use diuretics, etc) that it’s appalling. It’s not much better outpatient - I have gotten consults for “resistant hypertension” where the patient is on three meds at their starting doses. Their ICU training is at a community hospital where the sickest person is a guy with DKA or asthma requiring BIPAP. While I’m sure the training may be better elsewhere, i just hesitate to think that such trainees staffing an ICU or floor somewhere will be as competent as those coming out of an ostensibly “good” FM program

 

[LeroyJenkinsMD]

Incredibly weak IM programs exist.

Broad generalizations about all programs in any specialty are simply untrue. I can’t speak for every program in the country in the two largest specialties but maybe you guys can. All I know is that at my shop we see patients in all settings: clinic, ER, floor, unit, operating room, at follow up in clinic again and outcomes are just fine. Program has been around for decades and is still allowed to deliver good care. Assume what you want.

Crapping on others in order to feel superior is a sign of insecurity.

I have the utmost respect for anyone in any specialty that is a lifelong learner, is passionate about what they do, and practices good medicine. Their excellence is not mutually exclusive with mine.

*slowly walks backwards out of room before anyone shoots him for claiming to practice medicine as a physician.”

 

[CCM-MD]

I think it’s clear who’s insecure.

 

[IMreshopeful]

Incredibly weak IM programs exist.

Broad generalizations about all programs in any specialty are simply untrue. I can’t speak for every program in the country in the two largest specialties but maybe you guys can. All I know is that at my shop we see patients in all settings: clinic, ER, floor, unit, operating room, at follow up in clinic again and outcomes are just fine. Program has been around for decades and is still allowed to deliver good care. Assume what you want.

Crapping on others in order to feel superior is a sign of insecurity.

I have the utmost respect for anyone in any specialty that is a lifelong learner, is passionate about what they do, and practices good medicine. Their excellence is not mutually exclusive with mine.

*slowly walks backwards out of room before anyone shoots him for claiming to practice medicine as a physician.”

I’m not sure where you got that I was crapping on you. I said there’s good FM programs and bad FM programs. My hospital has a very bad one. Therefore, I don’t think those residents are prepared for practice as a hospitalist.

I’m not sure the fact that there’s bad IM programs has to do with what I said. I’m well aware there are terrible IM sweatshops. Doesn’t negate my point.

 

[rokshana]

Incredibly weak IM programs exist.

Broad generalizations about all programs in any specialty are simply untrue. I can’t speak for every program in the country in the two largest specialties but maybe you guys can. All I know is that at my shop we see patients in all settings: clinic, ER, floor, unit, operating room, at follow up in clinic again and outcomes are just fine. Program has been around for decades and is still allowed to deliver good care. Assume what you want.

Crapping on others in order to feel superior is a sign of insecurity.

I have the utmost respect for anyone in any specialty that is a lifelong learner, is passionate about what they do, and practices good medicine. Their excellence is not mutually exclusive with mine.

*slowly walks backwards out of room before anyone shoots him for claiming to practice medicine as a physician.”

funny, its seems like you are the one that is making broad generalizations and when someone calls you out you got your feathers ruffled...
the posts have stated that programs differ.

In general, FM (esp on the East cCoast) have little inpt exposure and when they do, the volume is low since they generally only see the pt of their practice (and only those that have been seem within in the last 3 years) and the rest, go to the IM service. There are exceptions of course... those that trained in unopposed program will have more exposure to the inpt setting as well more complicated pts.

If the average FM resident was completely ready for inpt, hospital service, then there would be no need for a HM fellowship after FM (there is no such thing in IM)...FM residency's focus and mission is more outpt and a broader pt population.

maybe you should take your own advice, because it seems that you are doing all those things that you are telling other people not to...

 

[VA Hopeful Dr]

funny, its seems like you are the one that is making broad generalizations and when someone calls you out you got your feathers ruffled...
the posts have stated that programs differ.

In general, FM (esp on the East cCoast) have little inpt exposure and when they do, the volume is low since they generally only see the pt of their practice (and only those that have been seem within in the last 3 years) and the rest, go to the IM service. There are exceptions of course... those that trained in unopposed program will have more exposure to the inpt setting as well more complicated pts.

If the average FM resident was completely ready for inpt, hospital service, then there would be no need for a HM fellowship after FM (there is no such thing in IM)...FM residency's focus and mission is more outpt and a broader pt population.

maybe you should take your own advice, because it seems that you are doing all those things that you are telling other people not to...

And that's part of the issue with FM residencies is there is so much variation. We don't really produce a standardized product outside of outpatient medicine. I know that no specialty does, but I think we have more variation than just about anyone else (which is to be expected given the breadth of the field). That and its easier to set up residency programs in FM than anything else so you have them at places that perhaps shouldn't.

 

[Gastrapathy]

I have seen jobs in surburban areas hiring only FM hospitalists as well although this is admittedly less common.

I find this exceedingly difficult to believe. Maybe at a very small hospital with a FM residency. But I doubt it.

 

[Scope guy]

personally I can say that there are more FM> IM jobs in primary care.many big institutions wont consider a IM grad for an open FM position. You dont need many pathways.